Die Onychomykose ist eine sehr häufige Erkrankung, deren Auftreten weltweit zunimmt und mit einer Pilzinfektion der Nägel einhergeht. Die Ineffizienz der verabreichte Antimykotika motiviert Bemühungen, nach alternativen Behandlungsmethoden zu suchen. Diese Dissertation untersucht die Auswirkungen der photodynamischen Inaktivierung (PDI) auf Dermatophyten und Schimmelpilze. Als Modellorganismen werden drei der Onychomykose auslösenden Pathogene untersucht: Trichophyton rubrum, Trichophyton interdigitale und der Schimmelpilz Scopulariopsis brevicaulis. Um das Potenzial der PDI gegen Onychomykose verursachende Pathogene, abzuschätzen, wurden Phototoxizitätstests mit drei Photosensibilisatoren (PS) durchgeführt: 5,10,15,20-Tetrakis(1-methylpyridinium-4-yl) porphyrintetra(p-toluenesulfonate) (TMPyP) und and 5,10,15-tris-(1-methylpyridinium-2-yl) corrolato-(trans-dihydroxo) phosphorus(V) (PCor+) sowie 4',5',7'-tetrabromo-3',6'-dihydroxyspiro[2-benzofuran-3,9'-xanthene] -1-one (Eosin G). Neben den Phototoxizitätstests wurden zeitaufgelöste Singulettsauerstoff-Lumineszenz Scans aufgenommen, die zur Verifizierung der PDI Effizienz genutzt wurden. Alle drei PS zeigen in vitro eine hohe phototoxische Wirkung. Diese konnte mit Singulettsauerstoff-Lumineszenzmessungen korreliert werden, bei denen ein hohes Singulettsauerstoff-Lumineszenzsignal erfasst wurde. An infizierten menschlichen Nägeln konnten die PS keinen phototoxischen Effekt induzieren. Singulettsauerstoff-Scans, die für einen Einblick in die zugrundeliegenden Ursachen durchgeführt wurden, zeigten fast kein Singulettsauerstoff-Lumineszenzsignal an menschlichen Nägeln. Könnten die verschiedenen bekannten Herausforderungen im Zusammenhang mit PDI an infizierten menschlichen Nägeln bewältigt werden, hätte die PDI das Potenzial, eine schnellwirkende Behandlung dieser Pilzinfektion im Zehennagel zu werden. Diese Studie zeigt erstmals den Zusammenhang zwischen der PDI-Behandlung von Onychomykose und Singulettsauerstoff. / Onychomycosis is a very common illness that befalls an increasing number of individuals worldwide and involves a fungal infection of the nails. The inefficiency of current treatments justifies the efforts to look for alternative treatment modalities. This dissertation investigates the impact of photodynamic inactivation (PDI) against dermatophytes and molds. Three of the causing pathogens of onychomycosis are under investigation: Trichophyton rubrum (T. rubrum), Trichophyton interdigitale (T. interdigitale) and the mold Scopulariopsis brevicaulis (S. brevicaulis). To assess the potential of PDI against onychomycosis causing pathogens, phototoxicity tests were performed using three photosensitizers (PSs): the cationic 5,10,15,20-Tetrakis(1-methylpyridinium-4-yl) porphyrintetra(p-toluenesulfonate) (TMPyP) and 5,10,15-tris-(1-methylpyridinium-2-yl) corrolato-(trans-dihydroxo) phosphorus(V) (PCor+) as well as the anionic 4',5',7'-tetrabromo-3',6'-dihydroxyspiro[2-benzofuran-3,9'-xanthene]-1-one (Eosin Y). Alongside the phototoxicity tests, time resolved singlet oxygen luminescence scans were conducted to serve as a control method of PDI. All three PSs proved to have a high phototoxic effect against the three fungi species in vitro. Those could be correlated with singlet oxygen measurements, where a high singlet oxygen luminescence signal was acquired. Contrary to the expectations from the in vitro experiments were the results obtained ex vivo: On infected human nails, the PSs were not able to induce a phototoxic effect. Singlet oxygen scans conducted to get insight into the reasons behind these results showed nearly no singlet oxygen luminescence signal on human nails. Addressing the various known challenges associated with PDI on infected human nails PDI would have a great impact within short time on treating the toenail fungal infection. This study, for the first time, shows the correlation between PDI treatment of onychomycosis and singlet oxygen.

Submitted by MARIA ÂNGELA LACERDA RANGEL ESPER null (angela_esper@hotmail.com) on 2016-04-13T16:41:11Z No. of bitstreams: 1 TESE FINAL ANGELA 2016.pdf: 1673462 bytes, checksum: 45fa78583c51eb4cc460fab26a8a4fc5 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-04-14T20:50:08Z (GMT) No. of bitstreams: 1 esper_malr_dr_sjc.pdf: 1673462 bytes, checksum: 45fa78583c51eb4cc460fab26a8a4fc5 (MD5) / Made available in DSpace on 2016-04-14T20:50:08Z (GMT). No. of bitstreams: 1 esper_malr_dr_sjc.pdf: 1673462 bytes, checksum: 45fa78583c51eb4cc460fab26a8a4fc5 (MD5) Previous issue date: 2016-02-16 / O trabalho in vitro avaliou a eficácia da inativação fotodinâmica (PDI) da eritrosina (E) e hematoporfirina IX (H), com 10 µM, utilizando LED azul, dose de 75 J/cm2 em células planctônicas e biofilme de S. mutans (UA 159). Suspensões padrões contendo 107 células/mL foram preparadas e submetidas a diferentes condições experimentais: a) hematoporfirina IX e LED (H+L+); b) eritrosina e LED (E+L+); c) apenas LED (F-L+); d) tratamento somente com hematoporfirina IX (H+L-); e) somente com eritrosina (E+L-); e f) grupo controle, sem tratamento com fotossensibilizador (F) e sem a utilização de LED (F-L-). As cepas foram semeadas em ágar MSBS para contagem de unidades formadoras de colônias (UFC/mL). Na segunda parte do trabalho foi realizado a PDI em biofilme de S. mutans sobre bráquetes metálicos e cerâmicos, com H a 10 µM e LED azul. Os resultados foram submetidos à análise de variância e teste de Tukey (p<0,05) e demonstraram que a E sob efeito do LED (E+L+) não foi eficaz na PDI de células planctônicas, nos parâmetros usados (p=0,3644). No entanto, a H promoveu redução de 6,78 log10 (p<0,0001), no grupo de tratamento (H+L+). A PDI com a associação da H e LED foi efetiva na redução de 100% de culturas planctônicas de S. mutans, porém o mesmo não foi observado na associação com a E, na dosimetria utilizada no experimento. A PDI no biofilme de S. mutans sobre bráquetes metálicos, com a H e LED não foi eficaz nos parâmetros utilizados (p=0,1023), no entanto, ocorreu diminuição significativa de 53% sobre bráquetes cerâmicos (p=0,004). A H IX modificada é promissora como agente fotossensibilizador a ser empregado na técnica de PDI em associação ao LED azul, sendo necessários outros ensaios, em novas concentrações e/ou dosimetrias para se conseguir a inativação bacteriana. / The in vitro study evaluated the efficacy of photodynamic inactivation (PDI) with erythrosine (E) and hematoporphyrin (H) 10 µM, using a blue light-emitting diode (LED), a fluence of 75 J/cm2 , on planktonic cultures and biofilm of S. mutans (UA 159). Suspensions containing 107 cells/mL were prepared and were tested under different experimental conditions: a) hematoporphyrin IX and LED (H+L+); b) erythrosine and LED irradiation (E+L+); c) only LED (P-L+); d) only hematoporphyrin IX (H+L-); e) only erythrosine (E+L-); and f) control group, no LED irradiation or photosensitizer (P) treatment (P-L-). After treatment, the strains were seeded onto MSBS agar in order to determine the number of colony-forming units (CFU/mL). The second part of this work consisted of the PDI of S. mutans biofilm on metal and ceramic brackets with the H 10 μM and blue LED. The results were submitted to analysis of variance and the Tukey test (p<0.05) and showed that E under the effect of LED proved to be ineffective in the PDI of planktonic cultures with the parameters used (p=0.3644). H, however, caused a reduction of 6.78 log10 (p<0.0001) in the treatment group (H+L+). PDI with H and LED exerted antimicrobial effect of 100% of the S. mutans strain studied, whereas the same was not observed in the association with E in the dosimetry used in this work. PDI on S. mutans biofilm on metal brackets, with H and LED was not effective with the parameters used (p=0.1023), however on ceramic brackets caused a significant reduction of 53% (p=0,004). Modified H IX is a promising photosensitizer to be used in the PDI technique in combination with blue LED. Therefore, new tests with new concentrations and/or dosimetry are needed to achieve bacterial inactivation.

Die Photodynamische Inaktivierung von Mikroorganismen (PDI) ist eine vielversprechende Methode zur Bekämpfung verschiedener Mikroorganismen. Grundlage der PDI ist die Generierung von reaktiven Sauerstoffspezies in toxischer Dosis, insbesondere von Singulettsauerstoff (1O2). Die Generierung von 1O2 erfolgt durch die Wechselwirkung eines Photosensibilisators mit Licht und molekularem Sauerstoff. Ein direkter Nachweis von 1O2 ist nur durch die Detektion seiner Phosphoreszenz bei 1269 nm (1O2 Lumineszenz) möglich. Die Kinetik der 1O2 Lumineszenz erlaubt Rückschlüsse auf die Mikroumgebung des Photosensibilisators. Die Phosphoreszenz-Quantenausbeute des 1O2 ist sehr gering und die spektrale Lage der 1O2 Lumineszenz bedingt geringe Detektionseffizienz und hohes Rauschen. Daher erfordert die zeitaufgelöste Detektion der 1O2 Lumineszenz hohen Aufwand an Technik und Fachwissen. Bisher gelang die zeitaufgelöste Detektion von 1O2 Lumineszenz an Mikroorganismen nur in Suspensionen. In dieser Arbeit werden Grundlagen für die Nutzung der orts- und zeitaufgelösten Detektion der 1O2 Lumineszenz auf Oberflächen als Werkzeug für die Evaluierung der PDI auf Oberflächen vorgestellt. Um diese Grundlagen zu schaffen, wurde ein Messplatz zur orts- und zeitaufgelösten Detektion von 1O2 Lumineszenz auf Oberflächen geplant, konstruiert, charakterisiert und getestet. In Untersuchungen an vier verschiedenen Mikroorganismen mit zwei Photosensibilisatoren gelingt erstmals der direkte, zeitaufgelöste Nachweis von 1O2 an Oberflächen kultivierter Mikroorganismen. Durch den Vergleich von Fluoreszenz-Scans und 1O2 Lumineszenz-Scans können Aussagen über das Diffusionsverhalten der Photosensibilisatoren und das 1O2 Lumineszenz Quenching der Mikro-organismen getroffen werden. Eine Analyse der 1O2 Lumineszenzkinetik zeigt, dass die Detektion der 1O2 Lumineszenz und die Bestimmung der 1O2 Lumineszenzkinetik im Zeitraum der PDI aller untersuchten Mikroorganismen möglich ist. / The Photodynamic Inactivation of Microorganisms (PDI) is a promising method to combat different microorganisms. The mechanism of PDI is based on the selective generation of reactive oxygen species, particularly of singlet oxygen (1O2), in a lethal dose. 1O2 is generated via the interaction of a photosensitizer with light and molecular oxygen. The only method for directly detecting 1O2 is the measurement of its characteristic phosphorescence at 1269 nm (1O2 luminescence). The kinetics of the 1O2 luminescence can be utilized to draw conclusions about the microenvironment of the photosensitizer. Due to the extremely low phosphorescence quantum yield of 1O2 and low detection efficiency because of its spectral position, the detection of 1O2 luminescence requires a considerable amount of specialised knowledge and technical efforts. Hitherto, the time-resolved detection of 1O2 luminescence at microorganisms has only been successful in suspensions. This thesis presents fundamentals for the use of laterally and time-resolved detection of 1O2 luminescence as a tool for evaluating PDI of microorganisms on surfaces. To provide these fundamentals, a setup for lateral and time-resolved 1O2 luminescence detection was planned, constructed and characterised. In studies regarding four different microorganisms and two photosensitizer, the direct time-resolved detection of 1O2 luminescence on the surface of cultured microorganisms was succeeded for the first time. The comparison of fluorescence and 1O2 luminescence scans allows gathering information about the diffusion properties of the photosensitizer as well as the quenching properties of the microorganisms. The analysis of the 1O2 luminescence kinetics exemplifies, that the determination of the 1O2 luminescence kinetics is possible over the period of the microorganisms’ PDI.